Job Description Summary

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Responsible for reviewing documentation for missing charges, open encounters and
open AR. There is a need to standardize, optimize, and increase accuracy and efficiency of revenue cycle processes, charge capture, billing and claims workflows. Plays a key supporting role in the overall strategy and optimization of revenue cycle operations, systems and policies. The vision for this position is someone who fully understands medical billing, and coding and isn’t afraid to investigate, is curious and driven to find answers, and up to the challenge to ensure accuracy, compliance, and adherence to industry standards. The role requires strong analytical skills, knowledge of billing regulations, and a commitment to quality assurance.

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How will you make an impact & Requirements

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Medical Coder (Revenue Cycle Auditor)

Position Qualifications/Essential Functions/Responsibilities:

• Review negative AR trends or inefficient processes and identify, assess and address root cause
• Audit Planning: Develop audit plans and strategies for reviewing billing and coding processes, considering relevant regulations, guidelines, and organizational policies
• Billing and Coding Audits: Conduct thorough audits of medical billing and coding activities to verify accuracy, completeness, and compliance with coding guidelines, payer requirements and regulatory standards
• Documentation Review: evaluate medical records, claims and billing documents to confirm that services rendered are properly documented, coded and billed in accordance with established policies and procedures
• Coding Accuracy: Assess the accuracy and appropriateness of diagnosis and procedure codes assigned to patient encounters ensuring alignment with clinical documentation and coding guidelines
• Root Cause Analysis: Investigate discrepancies, errors and variances identified during audits to determine root causes and recommend corrective actions to prevent recurrence
• Report Preparation: Prepare comprehensive reports summarizing findings, observations and recommendations for improvement
• Effective communication and collaboration with Providers, Practice Managers and other stakeholders

Additional Qualifications Preferred:

• Must possess the ability to think critically and articulate recommendations to leadership
• Must have ability to manage multiple projects concurrently
• Must possess the ability to seek out new methods and principles and be willing to incorporate them into existing practices.
• Proficiency with Microsoft Office Suite and Google tools

Education/Experience:

• 5 years or greater equivalent experience in professional or healthcare business-oriented industry
• 3+ years of relevant experience in healthcare billing and revenue cycle with a focus on healthcare reimbursement practices and experience with quality management required
• Experience in Revenue Cycle Systems integration (i.e. electronic claim automation, claims scrubber integration, ERA/EFT enrollment & automation, etc…)
• Coding certification required (AAPC or AHIMA) [apprentice excluded]
• Direct experience as a medical coder with a strong foundation in medical coding principles, including detailed knowledge of coding systems like ICD-10 and CPT procedural coding
• Experience with Family Practice, Primary Care and value based coding (HCC) preferred

Demonstrated Attributes:

• Team player with strong interpersonal skills and ability to build effective working relationships throughout all levels of the organization – Excellent verbal and written communication
• System thinker with the ability to be creative and innovative in a fast-paced environment with a lot of ambiguity and constant change
• Must function independently, have flexibility, personal integrity, and the ability to work effectively in a remote environment
• Highly organized and solution-focused
• Excellent attention to detail, analytical skills and problem-solving abilities
• Proficiency in conducting audits, analyzing data, and identifying trends and patterns.

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